Hello! This blog is about my daughter Hailey (currently 12 years old) and her experiences living with auditory processing disorder. Auditory Processing Disorder is Hailey's primary issue, however she has also been given the labels Sensory Processing Disorder, Dyslexia, Visual Processing Disorder, Mixed Expressive Receptive Language Disorder and Phonology Disorder at various points in her life.

Sunday, October 23, 2011

Auditory Processing Disorder: "A Manifestation of Impaired Neurocognitive Processes" and "One Factor in the Overall Profile of Different Developmental Disorders"

So, let’s start from the beginning. I wanted to research what the current thinking is on Auditory Processing Disorder because it seems to me that my daughter, as well as many of the other children I am learning about through my Auditory Processing Disorder (APD) groups, seems to have more than just auditory processing problems. Moreover, the label Auditory Processing Disorder is controversial and not recognized in the United States as a disability in and of itself. My concern is that my daughter, and all other people with the diagnosis APD, will not get the accommodations she needs at places such as school (not related to us as we homeschool), college (possibly in the future), and work (when she's an adult).

My daughter has all the usual problems associated with APD: difficulty localizing sounds in space, discriminating sounds, recognizing auditory patterns, responding to the temporal aspects of sounds (integration, discrimination, ordering, and masking), and extracting auditory information in less than ideal auditory environments. She also has the common attributes of APD of short term memory deficit and auditory recall problems – including word retrieval.

Like many children with APD, she has also been given additional diagnoses that coincidentally are the same diagnoses given to many other children also diagnosed with APD: Mixed Receptive-Expressive Language Disorder, Phonological Disorder, Attention Deficit Hyperactivity Disorder (ADHD) - only inattentive type, Sensory Processing Disorder, Visual Processing Disorder, Dyslexia, and the very broad term neurologically atypical. She was also suspected of Autism when younger by two pediatricians and ruled not Autistic by a pediatric psychologist.

Like a lot of children with special needs, she has had a variety of diagnoses and probably could have a variety more if we only brought her to the right specialist who would somehow find a way to make her fit the categories he or she is looking for. Personally, I find all these labels just weird little note tags at this point that all say: She has a problem with her brain and it affects her academically and socially. We notice it affects these particular areas and we don’t know what causes it or what to call it. It seems similar enough to these diagnoses and not similar enough to these.

Moreover, when researching each of these specific diagnoses, it is readily apparent that there is a lot of overlap among them. So how can one really differentiate where one begins and the other ends? This has been a question that has plagued me for some time.

How This Article Helps To Shed Light On the Confusion:

Now, on to this article which seems to make sense to me: Karen Banai and Rachel Yifat, the authors of the article, “Communications Disorder: Auditory Processing Disorder,” have gathered the loads of research results from various testing being done on APD as well as similar disorders around the world, and written their interpretation. To my understanding of their article, it seems that APD is most likely a “manifestation of impaired neurocognitive processes”2 and it seems to mostly be related to impaired attention processing and impaired context processing.3 APD relates to ADHD in the impaired attention processing.4 APD relates to Dyslexia and other language disorders, such as Specific Language Impairment (SLI), in impaired context processing.5

Furthermore, it is believed a possibility that APD is “one factor contributing to the overall profile of symptoms in different developmental disorders.”6 This makes huge amounts of sense to me as it seems to me that many children with APD also have other issues, i.e. Sensory Processing Disorder, Visual Processing Disorder, Autism Spectrum Disorder, and those that seem to overlap with APD such as ADHD, SLI, and Dyslexia.

All of this research, in my opinion, suggests that it does not matter what diagnosis you give to a child and that perhaps the diagnoses themselves are flawed and limited in their criteria. What matters is that you do what you can to provide the interventions and support each child needs to be as successful as possible at academics, as well as living life in general, including socializing. As Banai and Yifat put it, “The reservations… concerning the necessity of the separate diagnosis of APD should not obscure the troubling fact that no matter what diagnosis they have received, the outcomes for many children with learning disabilities (estimated at 25% by Hatcher et al., 2006) even following gold standard interventions are not encouraging.”

My Lesson Learned as a Parent:

The experts haven't figured it all out and really don't understand the brain and its processes well enough at this point to agree upon proper labels, categories, causes, etc. So, stop worrying about the diagnoses and concentrate on helping my child academically, socially, and with life in general. Look at her particular needs and address them on an individual basis. When she gets ready to go to college, get a job, or do anything else that requires us getting special accommodations, well, let's hope the rules are less stringent than they are now, and they'll look at her as an individual and what she can/cannot do, rather than as a list of diagnoses.

2”Another option is that what appears as APD is merely a manifestation of impaired neurocognitive processes such as auditory attention or memory which lead to difficulties in challenging listening conditions.”

3”Taken together, it seems that auditory processing deficits are part of the clinical picture of several developmental disorders, including dyslexia and SLI, even though causal relationships are poorly understood. Theoretically, this clinical picture suggests several possibilities. One option is that poor auditory processing is one factor contributing to the overall profile of symptoms in different developmental disorders (Dawes and Bishop, 2009). Another option is that what appears as poor auditory processing actually reflects a problem in other cognitive processes such as attention or context processing.”

4”Finally, the findings of one study suggest that children diagnosed with APD were distinguishable from children diagnosed with ADHD in terms of their verbal memory spans (Maerlender, 2007), but neither auditory attention data, nor information on other aspects of performance were provided. Therefore, the lower memory spans in the APD children could have been a part of a more general disorder involving both language and attention. Indeed, it has been shown that both ADHD and APD are associated with high incidences of inattentive and distracted behaviors (Chermak, 2007).”

“However, a careful analysis of performance on the auditory tasks revealed that poor performance typically results from poor auditory attention, rather than from a specific deficit in the spectral or temporal analysis of sound (Ferguson, Riley, Ratib, Edmondson-Jones, and Moore, 2009).”

5”Furthermore, there are few apparent differences between children diagnosed with APD and those diagnosed with dyslexia or language problems on measures of both auditory and language processing (Dawes et al., 2009; King, Lombardino, Crandell, and Leonard, 2003)”.

“In particular, individuals with dyslexia perform poorly on tasks in which performance in the general population benefits from the consistent presentation of repeated anchor stimuli, consistent with the idea that individuals with dyslexia are not making as efficient use of the context of recently presented stimuli as does the general population (Ahissar, Lubin, Putter-Katz, and Banai, 2006).”

6”Taken together, it seems that auditory processing deficits are part of the clinical picture of several developmental disorders, including dyslexia and SLI, even though causal relationships are poorly understood. Theoretically, this clinical picture suggests several possibilities. One option is that poor auditory processing is one factor contributing to the overall profile of symptoms in different developmental disorders (Dawes and Bishop, 2009). Another option is that what appears as poor auditory processing actually reflects a problem in other cognitive processes such as attention or context processing.”